Current perspectives on co-morbid depression and multiple sclerosis.

INTRODUCTION

Depression is a common comorbidity in multiple sclerosis. Depression in MS often requires treatment due to its negative impact on quality of life, functioning, and MS outcomes. However, there have been very few randomized controlled trials of treatment of depression in MS. Most reviews of this topic have consequently presented a predominantly negative assessment of antidepressant treatment, concluding, for example, that there is insufficient evidence to guide treatment or that evidence only exists for a few uncommon antidepressant medications or forms of treatment.

AREAS COVERED

This review will provide a summary of currently available literature on depression in MS, with an emphasis on the clinical utility of available information. This includes information from published therapeutic trials, but also how general aspects and principles of depression treatment can guide neurotherapeutics in this area.

EXPERT OPINION

Management of depression in MS should be guided primarily by available evidence on depression treatment and not exclusively by the small and inadequate literature of randomized controlled trials. Differential diagnosis is important since depression manifests across a broad spectrum of morbidity in MS, a reality that has real-world implications for treatment. Basic guiding principles can support management of depression in people with MS.